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From the 4/23/2021 release of VAERS data:

This is VAERS ID 133837



Case Details

VAERS ID: 133837 (history)  
Form: Version 1.0  
Age: 0.37  
Sex: Female  
Location: Tennessee  
Vaccinated:2000-02-08
Onset:2000-02-08
   Days after vaccination:0
Submitted: 2000-02-08
   Days after onset:0
Entered: 2000-02-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914AZ / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0359J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0H23 / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Breath sounds abnormal, Crying, Cyanosis, Exophthalmos, Respiratory disorder, Salivary hypersecretion
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Hyperthyroidism (narrow), Depression (excl suicide and self injury) (broad), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synagis of Mouth
Current Illness: NONE
Preexisting Conditions: 29 wk premie
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 5 min post vax, pt turned blue, eyes buldging, making gurgling breath sounds, milky secretions from mouth. She had been crying very hard during immunizations. Pt (mucus milk) suctioned, gave O2. Admitted to hosp for observation. Follow-up: 2/9/00 no answer - no machine. Will try again 2/10. 2/14 - per mom via phone. - Was in hosp. $g 24 hrs. - Had some dgx study done. - Thinks dgx was: "crying too hard". - Will send her release form and get D/C summary from hospital.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133837


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